Aids, the procedure that will allow children to suspend therapy
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A new diagnostic procedure to find out which of the children infected with HIV and in treatment could stop antiretroviral therapy without repercussions for their health. This is what the white coats of the Bambino Gesù Pediatric Hospital in Rome are about to experiment with, aiming to reduce the impact of treatment on the little ones. How? Through a risk stratification based on the quantification of the so-called residual viral load, thanks to which it may soon no longer be necessary for the youngest to receive antiretroviral therapy for life. Not just a hope, announced on the eve of World Aids Day on 1 December.
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Hiv, what is the residual viral load
Residual viral load (or viral reserve) indicates the amount of virus that remains in some cells (CD4) present on T lymphocytes of people with HIV infection. This, still today, represents the main obstacle to complete recovery. The presence and quantification of the residue, in fact, are the parameters that eventually make lifelong antiretroviral therapy necessary.
Very often, however, in children who have inherited the virus from their mother (vertical transmission, underlying 95% of cases of pediatric infection) and who started antiretroviral therapy early, the amount of this residue is reduced. And it may no longer require such a tight course of care. Provided, of course, that we are able to quantify the presence of the virus in T lymphocytes (CD4) with extreme accuracy.
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A new opportunity thanks to a less invasive exam
The main novelty of the approach developed by the researchers and clinicians of the Child Jesus consists in no longer having to need large quantities of blood to quantify the viral residue. To overcome this problem, white coats investigated the application of a procedure to obtain an optimal amount of cells ready for characterisation. This is leukapheresis which, through a special machine, allows only the white blood cells to be taken and the rest of the blood to be put back into circulation.
The procedure was safe for young patients and effective: with a cellular yield up to 250,000 times greater than traditional sampling techniques. The material obtained with leukapheresis has allowed doctors and researchers of the Child Jesus to perform a new molecular characterization of the viral reserve. Evaluating what was also the protective immune response associated with individual cases, the doctors have come to divide the children on the basis of the characteristics of the reserve. “In children in whom this reserve turns out to be completely dormant, it is possible to proceed with therapeutic suspension: this is a goal pursued for years by doctors and researchers who deal with HIV”, he explains Paul Palma, head of the Clinical Immunology and Vacciniology Research Unit of the Bambino Gesù Pediatric Hospital, who in February will present the results of the two works in Seattle, during the Conference dedicated to retroviruses and opportunistic infections (CROI). In all likelihood, the trial of discontinuing antiretroviral therapy in children with a dormant viral reserve will also begin in the same period.
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In Italy, over 700 children and adolescents have been affected
Those potentially affected by this discovery are the families of almost 1.7 million children worldwide affected by HIV and undergoing a therapy that leads them to take up to ten medicines a day (including pills and syrups). Over 9 out of 10 of these cases result from vertical transmission. Compared with other European countries and in the world, Italy is one of the countries with the lowest incidence of this problem: according to the data reported in a study published in the Journal of HIV and Agingin 2017, over 700 infected children and adolescents are followed up.
Over the years, the rate of perinatal transmission of HIV infection has been decreasing. If at the beginning of the century it was around 10% (of total newborns), today it has dropped drastically (below two percent). thanks above all to the use of antiretroviral therapy already during pregnancy, which however is not available in a homogeneous way in the world. This explains why the problem is increasingly represented by foreign mothers who come to the attention of Italian doctors: above all from sub-Saharan Africa and Eastern Europe.
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